Kidney Week

Abstract: TH-OR128

Economic Evaluation of Lifelong Medicare Immunosuppressive Drug Coverage for Kidney Transplant Recipients

Session Information

• Policy and Pretransplant Considerations
  November 07, 2019 | Location: 151, Walter E. Washington Convention Center
  Abstract Time: 04:30 PM - 04:42 PM

Category: Transplantation

• 1902 Transplantation: Clinical

Authors

• Kadatz, Matthew J., University of British Columbia, Vancouver, British Columbia, Canada

Matthew J. Kadatz, MD



Dr. Kadatz completed his nephrology training at the University of British Columbia, followed by his kidney transplant fellowship at the University of Toronto. After a two year research fellowship in the Clinician Investigator Program at UBC, he started as a transplant nephrologist at Vancouver General Hospital. He is currently a Clinical Assistant Professor in at the University of British Columbia and his research primarily centres around health economics in kidney disease.

• Gill, John S., (St. Paul's Hospital/University of British Columbia), Vancouver, British Columbia, Canada

John S. Gill,

• Formica, Richard Nicholas, Yale School of Medicine, Bethany, Connecticut, United States

Richard Nicholas Formica,

• Klarenbach, Scott, University of Alberta, Edmonton, Alberta, Canada

Scott Klarenbach,

Background

Medicare coverage for kidney transplant recipients ceases 36 months after transplantation. This policy removes coverage for life-saving immunosuppressive medications essential to prevent rejection and maintain transplant function.
A contemporary economic analysis of extending Medicare coverage for the duration of transplant survival using mean cost of immunosuppressant medications in the era of generic equivalents which accounts for that fact that many transplant recipients currently continue to receive Medicare coverage beyond 36 months due to medical disability is not available.

Methods

A Markov model was used to determine the incremental cost and effectiveness of extending Medicare coverage for immunosuppressive drugs for the duration of transplant survival compared with the current policy from the perspective of the Medicare payer. The model used contemporary mean costs of immunosuppressive medications, and incorporated assessment of continuation of Medicare coverage beyond 36 months in patients who are designated medically disabled. The expected graft survival of extending immunosuppressive drug coverage was estimated from a cohort of privately insured transplant recipients using multivariable survival analysis.

Results

Extension of immunosuppression coverage under Medicare for kidney transplant recipients led to lower costs of -$3,163 and 0.18 additional quality adjusted life years (QALYs). When the improvement in transplant survival associated with extending immunosuppressive coverage was reduced to 50% of that observed in privately insured patients, the strategy of extending drug coverage had an ICUR of $77,613/ QALY gained.

Conclusion

Extending immunosuppressive drug coverage under Medicare from the current 36 months to the duration of transplant survival will result in better patient outcomes and cost savings, and remains cost-effective if only a fraction of anticipated benefit is realized.